Children can also suffer from strokes
Many healthcare practitioners and parents unaware diagnosis also occurs in childhood and not only in the elderly
Maddie Greenwood’s world is filled with music, fashion and friends. A keen swimmer and rider, she loves taking pictures on her phone.
Nine years ago she suffered a clot on the brain and her mother Claire Redfern admits “she can have a bit of a temper”.
She is – if such a thing exists – a typical 12-year-old girl.
Nine years ago, Maddie had a stroke. A splint supports her right leg and foot, she has little use of her right hand, and she finds school work challenging and tires easily.
Stroke is the UK’s fourth largest cause of death and Maddie is one of 400 children to have one each year. Yet, awareness of its incidence in young people remains low. Delays in diagnosis and treatment, and patchy support, have compromised long-term outcomes for many of them.
New guidelines from the Royal College of Paediatric and Child Health (RCPCH) aim to heighten awareness among professionals, and equip parents with clear information.
Redfern admits to once being among the masses who weren’t aware stroke can occur in childhood and, she adds, even many health workers are unsure of the signs.
Even after diagnosis, accessing support for Maddie has been a battle. “When she was 10, the occupational therapists wanted to sign her off. She wasn’t using her hand. How can that be right? You are supposed to be entitled to continued rehabilitation if you have had a stroke. But trying to get it is another story.”
The possibility of stroke was first mentioned to Redfern 24 hours after she ran into her local emergency department holding Maddie in her arms. Unusually, Redfern had woken Maddie, then three, at 8am on a Sunday, finding her unresponsive.
Doctors suspected an infection or virus. “It wasn’t obvious there was any one-sided weakness because she was limp all over,” recalls Redfern. The following morning, Maddie was seen on the consultant’s ward round. “She told me she suspected a stroke and that Maddie needed a CT scan. I was in disbelief. I thought stroke only affected the elderly.”
Brain imaging is the only way to diagnose a stroke, and the delay in its use on children is a key shortcoming in identification and treatment. One recommendation is that all children in whom stroke is suspected should have a CT scan within an hour of arriving in hospital.
“The consultant neurologist explained that a clot had travelled to Maddie’s brain and she’d had a significant stroke,” said Redfern. “I remember pictures of a brain and there was a big black bit where her tissue had effectively died.”
No reason was found for Maddie’s stroke, which is not uncommon. The causes of childhood stroke are still being researched but are known to include inflammation after an infection, blood clotting or vessel disorders, and congenital heart disease.
Maddie was treated with aspirin to prevent further clots and a series of therapists assessed her needs. After being discharged two weeks later, these therapies continued at home and as an outpatient.
The initial focus was on walking and talking. Two months after her stroke, Maddie was fitted with a leg splint and took her first steps.
When Maddie was five, she asked about her condition. “We always said she had a tricky hand and leg. She just said, ‘Mummy, why am I tricky when nobody else is?’ Then she started to cry.”
When Maddie started school, Redfern tried to get a statement of special educational needs to ensure her daughter got the right help. “I had to fight hard. It was turned down at first, even though all the experts had recommended it.
“I took Maddie to the meeting and had the official watch her struggle to walk to the room. Everything was more of a challenge for her. That and fighting to get ongoing therapies have been the themes ever since.”
Anne Gordon, a neuroscientist, runs the Childhood Stroke Project in partnership with the Stroke Association, and worked on the new guidelines.
“I hope we will now see better recognition across healthcare professionals that childhood stroke happens and that these children deserve quick diagnosis, support and care.” –